【摘要】 目的:介绍颞下颌关节(TMJ)镜下治疗囊内黏连(IA)的术式,评价关节镜手术治疗TMJ上腔IA的疗效。方法:对142例(159侧)关节镜下证实有黏连的关节行黏连松解术、囊内清扫修整术或射频消融术,其中110例(123侧)伴随关节盘移位者,行关节盘复位固定术。术后随访检查包括患者的颌骨运动度、VAS疼痛测量值及自我评价。疗效分为优、良、差3级,将优、良定为手术有效;采用SPSS11.0软件包对手术前、后颌骨运动度和VAS疼痛测量值分别进行配对t检验。结果:平均随访期10.3个月(1～27个月)。疗效评价优33.80%(48/142),良56.34%(80/142),差9.86%(14/142);总有效率90.14%(128/142)。93.66%(133/142)的患者自主症状较术前明显改善。术前平均开口度(23.14±5.93)mm(10～40mm),术后平均开口度(37.48±3.51)mm(30～40mm),较术前显著改善,经统计学处理有显著性差异(P<0.01)。疼痛的VAS测量值术前平均28.94±23.54(0～80),术后平均4.44±10.10(0～50),手术前、后VAS测量值有显著差异(P<0.05)。结论:关节镜手术治疗TMJIA疗效肯定,能增大患者的开口度,改善功能,减轻颌骨运动时的疼痛。更多还原

【Abstract】 PURPOSE:To introduce arthroscopic treatment of adhesion and evaluate the effect of arthroscopic surgery on IA of TMJ upper compartment. METHODS:142 patients(159 joints) with intraarticular adhesion confirmed by arthroscope were treated with lysis of adhesions,intraarticular clean-up operation or capsules radiofrequency catheter ablation. 110 patients(123 joints) accompanied with disc displacement underwent disc repositioning and suturing. The follow-up index included jaw movement,VAS pain value and patients’ self-evaluation. The therapeutic effect was divided into excellent,good and poor,and excellent and good patients were defined effective. Jaw movement and VAS pain value before and after operation were evaluated by paired t test using SPSS11.0 software package. RESULTS:The average follow-up period was 10.3 months(2 to 27 months) . 33.80%(48/142) of all joints was excellent;56.34%(80/142) of all joints was good,and only 9.86%(14/142) was poor. The total effective rate was 90.14%(128/142) . 93.66%(133/142) ofall patients felt more comfortable than that of before operation. The interincisal opening increased from preoperative(23.14±5.93) mm(range from 10 to 40mm) to postoperative(37.48±3.51) mm(range from 30 to 40mm)(P<0.01) ,and the pain scores reduced from 28.94±23.54(0～80) to 4.44±10.10(0～40) (P<0.05) . CONCLUSIONS:The effect of arthroscopic surgery on TMJ IA is affirmative. Surgery can increase the patients’ mouth opening,improve jaw function and reduce pain in the jaw movement.更多还原